Active distal tip drive

ABSTRACT

A method and system of correcting alignment of catheter relative to a target including receiving signals from an inertial measurement unit located at a distal end of a catheter, determining movement of the distal end of the catheter caused by physiological forces, receiving images depicting the distal end of the catheter and the target, identifying the distal end of the catheter and the target in the images, determining an orientation of the distal end of the catheter relative to the target and articulating the distal tip of the catheter in response to the detected movement to achieve and maintain an orientation towards the target such that a tool extended from an opening at the distal end of the catheter would intersect the target.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.17/307,790, filed on May 4, 2021, which claims the benefit of andpriority to U.S. Provisional Patent Application No. 63/034,501, filed onJun. 4, 2020, the entire disclosure of each of which is incorporated byreference herein.

BACKGROUND Technical Field

This disclosure relates to the field of navigation of and maintainingposition of medical devices, such as biopsy or ablation tools, relativeto targets.

Description of Related Art

There are several commonly applied medical methods, such as endoscopicprocedures or minimally invasive procedures, for treating variousmaladies affecting organs including the liver, brain, heart, lungs, gallbladder, kidneys, and bones. Often, one or more imaging modalities, suchas magnetic resonance imaging (MRI), ultrasound imaging, computedtomography (CT), or fluoroscopy are employed by clinicians to identifyand navigate to areas of interest within a patient and ultimately atarget for biopsy or treatment. In some procedures, pre-operative scansmay be utilized for target identification and intraoperative guidance.However, real-time imaging may be required to obtain a more accurate andcurrent image of the target area. Furthermore, real-time image datadisplaying the current location of a medical device with respect to thetarget and its surroundings may be needed to navigate the medical deviceto the target in a safe and accurate manner (e.g., without causingdamage to other organs or tissue).

For example, an endoscopic approach has proven useful in navigating toareas of interest within a patient, and particularly so for areas withinluminal networks of the body such as the lungs, blood vessels,colorectal cavities, and the renal ducts. To enable the endoscopicapproach, navigation systems have been developed that use previouslyacquired MM data or CT image data to generate a three-dimensional (3D)rendering, model, or volume of the particular body part.

The resulting volume generated from the MRI scan or CT scan may beutilized to create a navigation plan to facilitate the advancement of anavigation catheter (or other suitable medical device) through theluminal network to an area of interest. A locating or tracking system,such as an electromagnetic (EM) tracking system or shape sensingtracking system, may be utilized in conjunction with, for example, CTdata, to facilitate guidance of the navigation catheter to the area ofinterest.

However, once a catheter is navigated to a desired location the positionof the catheter within the patient is constantly in flux. Change inposition of the catheter may be caused by the movement of tools throughthe catheter, movement of the lungs themselves during respiration, andmovement caused by the proximity of the lungs to the heart which is inconstant motion as part of the cardiac process. Accordingly,improvements to current systems are desired.

SUMMARY

One aspect of the disclosure is directed to a method of maintainingorientation of a catheter relative to a target including: navigating acatheter in a luminal network, collecting data relating to movement of adistal tip of the catheter caused by physiological forces. The method ofmaintaining orientation also includes receiving images depicting thedistal tip of the catheter and the target. The method of maintainingorientation also includes identifying the distal tip of the catheter andthe target in the images. The method of maintaining orientation alsoincludes determining an orientation of the distal tip of the catheterrelative to the target. The method of maintaining orientation alsoincludes confirming that the distal tip is oriented at the target. Themethod of maintaining orientation also includes articulating the distaltip of the catheter to maintain the orientation at the target based onthe collected data. Other embodiments of this aspect includecorresponding computer systems, apparatus, and computer programsrecorded on one or more computer storage devices, each configured toperform the actions of the methods and systems described herein.

Implementations of this aspect of the disclosure may include one or moreof the following features. The method where the collected data isreceived from an inertial measurement unit. The method further includingdetermining a three-dimensional angle between a current orientation ofthe distal tip of the catheter and an orientation where a vectorextending from the distal tip of the catheter intersect the target. Themethod further including articulating the distal tip of the catheter toachieve the orientation where the vector extending from the distal tipof the catheter intersect the target. The method where the images arefluoroscopic images. The method where the images are ultrasound images.The method where the physiological forces are caused by respiration andcardiac functions. The method where the data is collected duringnavigation of the catheter towards the target. The method furtherincluding presenting on a user interface a virtual catheter tip and avirtual target. The method further including presenting an indicator onthe user interface when the physiological forces are in approximatelythe same phase of their cycle as when the distal tip was confirmedoriented at the target. Implementations of the described techniques mayinclude hardware, a method or process, or computer software on acomputer-accessible medium, including software, firmware, hardware, or acombination of them installed on the system that in operation causes orcause the system to perform the actions. One or more computer programscan be configured to perform particular operations or actions by virtueof including instructions that, when executed by data processingapparatus, cause the apparatus to perform the actions.

Another aspect of the disclosure is directed to a method of correctingalignment of catheter relative to a target including: receiving signalsfrom an inertial measurement unit located at a distal end of a catheter,determining movement of the distal end of the catheter caused byphysiological forces. The method of correcting alignment of catheteralso includes receiving images depicting the distal end of the catheterand the target. The method of correcting alignment of catheter alsoincludes identifying the distal end of the catheter and the target inthe images. The method of correcting alignment of catheter also includesdetermining an orientation of the distal end of the catheter relative tothe target. The method of correcting alignment of catheter also includesarticulating the distal tip of the catheter to achieve and maintain anorientation towards the target such that a tool extended from an openingat the distal end of the catheter would intersect the target. Otherembodiments of this aspect include corresponding computer systems,apparatus, and computer programs recorded on one or more computerstorage devices, each configured to perform the actions of the methodsand systems described herein.

Implementations of this aspect of the disclosure may include one or moreof the following features. The method further including determining athree-dimensional angle between a current orientation of the distal endof the catheter and an orientation where a vector extending from thedistal end of the catheter intersect the target. The method where theimages are fluoroscopic images. The method where the images areultrasound images. The method where the physiological forces are causedby respiration and cardiac functions. The method where the data iscollected during navigation of the catheter towards the target.Implementations of the described techniques may include hardware, amethod or process, or computer software on a computer-accessible medium,including software, firmware, hardware, or a combination of theminstalled on the system that in operation causes or cause the system toperform the actions. One or more computer programs can be configured toperform particular operations or actions by virtue of includinginstructions that, when executed by data processing apparatus, cause theapparatus to perform the actions.

A further aspect of the disclosure is directed to a system formaintaining orientation of a catheter towards a target including: acatheter including an inertial measurement unit (IMU), the IMUconfigured to generate signals relating to movement of the distalportion of the catheter, and a drive mechanism configured to articulatethe distal portion of the catheter; and a computing device, thecomputing device including a processor and memory, the memory storingthereon instructions that when executed by the processor, receivesignals from the IMU; determine motion of the IMU caused byphysiological forces; receive images depicting the distal portion of thecatheter and a target; determine the orientation of the distal portionof the catheter relative to the target based on the images; and sendsignals to the drive mechanism to articulating the distal portion of thecatheter to achieve and maintain an orientation towards the target suchthat a tool extended from an opening at the distal portion of thecatheter would intersect the target. Other embodiments of this aspectinclude corresponding computer systems, apparatus, and computer programsrecorded on one or more computer storage devices, each configured toperform the actions of the methods and systems described herein.

Implementations of this aspect of the disclosure may include one or moreof the following features. The system where the memory stores thereoninstructions that when executed by the processor, determine athree-dimensional angle between a current orientation of the distalportion of the catheter and an orientation where a vector extending fromthe distal portion of the catheter intersect the target. The systemwhere the movement of the distal portion of the catheter is a result ofphysiological forces including respiration and cardiac function. Thesystem where the received images are fluoroscopic images.Implementations of the described techniques may include hardware, amethod or process, or computer software on a computer-accessible medium,including software, firmware, hardware, or a combination of theminstalled on the system that in operation causes or cause the system toperform the actions. One or more computer programs can be configured toperform particular operations or actions by virtue of includinginstructions that, when executed by data processing apparatus, cause theapparatus to perform the actions.

BRIEF DESCRIPTION OF THE DRAWINGS

Various aspects and embodiments of the disclosure are describedhereinbelow with references to the drawings, wherein:

FIG. 1 is a schematic view of a luminal network navigation system inaccordance with the disclosure;

FIG. 2 is a user interface in accordance with the disclosure;

FIGS. 3A and 3B depict aspects of an articulation system for a catheterin accordance with the disclosure;

FIG. 4 is a flow chart of a method of local registration in accordancewith the disclosure;

FIG. 5 is view as may appear on a user interface depicting theorientation of a distal portion of a catheter relative a target;

FIG. 6 is a flow chart describing a method of achieving and maintainingorientation of a distal portion of a catheter and a target;

FIG. 7 is a schematic view of an imaging and computing system inaccordance with the disclosure.

DETAILED DESCRIPTION

Catheters and catheter like devices, such as endoscopes, are used in amyriad of medical procedures. These flexible devices are typically usedto navigate through luminal networks of the body including thevasculature, airways, and digestive systems. In accordance with thedisclosure, to aide in navigating to a specific location, the distal tipof the catheter can be articulated, deflected, or rotated by a userthrough controls on the catheter proximal end outside the body. Thesemanipulations allow the tip to point towards and enter branchingstructures. Upon arrival at the desired anatomic location a medicalprocedure may be performed such as lesion observation, heart valvereplacement, stent or pacemaker deployment, radio frequency or microwaveablation, placement of chemotherapy drugs, and a variety of others.

In accordance with the disclosure, a 3D model of a patient's lungs oranother suitable portion of the anatomy, may be generated frompreviously acquired scans, such as CT or MRI scans. The 3D model andrelated scan data are used to identify targets, e.g., potential lesionsfor biopsy or treatment, and to generate a pathway plan through theanatomy to reach the targets.

Once the pathway plan is generated and accepted by a clinician, thatpathway plan may be utilized by a navigation system to drive a catheteror catheter like device along the pathway plan through the anatomy toreach the desired target. The driving of the catheter along the pathwayplan may be manual or it may be robotic, or a combination of both.Manual systems include the ILLUMISITE navigation system sold byMedtronic PLC, robotic systems include the ION system sold by IntuitiveSurgical Inc. and the MONARCH system sold by Auris Health, Inc. In asingle procedure planning, registration of the pathway plan to thepatient, and navigation are performed to enable a medical device, e.g.,a catheter to be navigated along the planned path to reach a target,e.g., a lesion, so that a biopsy or treatment of the target can becompleted.

FIG. 1 is a perspective view of an exemplary system for facilitatingnavigation of a medical device, e.g., a catheter to a soft-tissue targetvia airways of the lungs. System 100 may be further configured toconstruct fluoroscopic based three-dimensional volumetric data of thetarget area from 2D fluoroscopic images to confirm navigation to adesired location. System 100 may be further configured to facilitateapproach of a medical device to the target area by using ElectromagneticNavigation (EMN) and for determining the location of a medical devicewith respect to the target. One such EMN system is the ILLUMISITE systemcurrently sold by Medtronic PLC, though other systems for intraluminalnavigation are considered within the scope of the disclosure includingshape sensing technology which detect the shape of the distal portion ofthe catheter and match that shape to the shape of the luminal network ina 3D model.

One aspect of the system 100 is a software component for reviewing ofcomputed tomography (CT) image scan data that has been acquiredseparately from system 100. The review of the CT image data allows auser to identify one or more targets, plan a pathway to an identifiedtarget (planning phase), navigate a catheter 102 to the target(navigation phase) using a user interface on computing device 122, andconfirming placement of a sensor 104 relative to the target. The targetmay be tissue of interest identified by review of the CT image dataduring the planning phase. Following navigation, a medical device, suchas a biopsy tool or other tool, may be inserted into catheter 102 toobtain a tissue sample from the tissue located at, or proximate to, thetarget.

As shown in FIG. 1 , catheter 102 is part of a catheter guide assembly106. In one embodiment, catheter 102 is inserted into a bronchoscope 108for access to a luminal network of the patient P. Specifically, catheter102 of catheter guide assembly 106 may be inserted into a workingchannel of bronchoscope 108 for navigation through a patient's luminalnetwork. The he catheter 102 may itself include imaging capabilities andthe bronchoscope 108 is not strictly required. A locatable guide (LG)110 (a second catheter), including a sensor 104 may be inserted intocatheter 102 and locked into position such that sensor 104 extends adesired distance beyond the distal tip of catheter 102. The position andorientation of sensor 104 relative to a reference coordinate system, andthus the distal portion of catheter 102, within an electromagnetic fieldcan be derived. Catheter guide assemblies 106 are currently marketed andsold by Medtronic PLC under the brand names SUPERDIMENSION® ProcedureKits, or EDGE™ Procedure Kits, and are contemplated as useable with thedisclosure.

System 100 generally includes an operating table 112 configured tosupport a patient P, a bronchoscope 108 configured for insertion throughpatient P's mouth into patient P's airways; monitoring equipment 114coupled to bronchoscope 108 or catheter 102 (e.g., a video display, fordisplaying the video images received from the video imaging system ofbronchoscope 108 or the catheter 102); a locating or tracking system 114including a locating module 116, a plurality of reference sensors 18 anda transmitter mat 120 including a plurality of incorporated markers; anda computing device 122 including software and/or hardware used tofacilitate identification of a target, pathway planning to the target,navigation of a medical device to the target, and/or confirmation and/ordetermination of placement of catheter 102, or a suitable devicetherethrough, relative to the target.

In accordance with aspects of the disclosure, the visualization ofintra-body navigation of a medical device, e.g., a biopsy tool, towardsa target, e.g., a lesion, may be a portion of a larger workflow of anavigation system. A fluoroscopic imaging device 124 capable ofacquiring fluoroscopic or x-ray images or video of the patient P is alsoincluded in this particular aspect of system 100. The images, sequenceof images, or video captured by fluoroscopic imaging device 124 may bestored within fluoroscopic imaging device 124 or transmitted tocomputing device 122 for storage, processing, and display. Additionally,fluoroscopic imaging device 124 may move relative to the patient P sothat images may be acquired from different angles or perspectivesrelative to patient P to create a sequence of fluoroscopic images, suchas a fluoroscopic video. The pose of fluoroscopic imaging device 124relative to patient P while capturing the images may be estimated viamarkers incorporated with the transmitter mat 120. The markers arepositioned under patient P, between patient P and operating table 112and between patient P and a radiation source or a sensing unit offluoroscopic imaging device 124. The markers incorporated with thetransmitter mat 120 may be two separate elements which may be coupled ina fixed manner or alternatively may be manufactured as a single unit.Fluoroscopic imaging device 124 may include a single imaging device ormore than one imaging device.

Computing device 122 may be any suitable computing device including aprocessor and storage medium, wherein the processor is capable ofexecuting instructions stored on the storage medium. Computing device122 may further include a database configured to store patient data, CTdata sets including CT images, fluoroscopic data sets includingfluoroscopic images and video, fluoroscopic 3D reconstruction,navigation plans, and any other such data. Although not explicitlyillustrated, computing device 122 may include inputs, or may otherwisebe configured to receive, CT data sets, fluoroscopic images/video andother data described herein. Additionally, computing device 122 includesa display configured to display graphical user interfaces. Computingdevice 122 may be connected to one or more networks through which one ormore databases may be accessed.

With respect to a planning phase, computing device 122 utilizespreviously acquired CT or MM image data for generating and viewing athree-dimensional model or rendering of patient P's airways, enables theidentification of a target on the three-dimensional model(automatically, semi-automatically, or manually), and allows fordetermining a pathway through patient P's airways to tissue located atand around the target. More specifically, CT images acquired fromprevious CT or MM scans are processed and assembled into athree-dimensional volume, which is then utilized to generate athree-dimensional model of patient P's airways. The three-dimensionalmodel may be displayed on a display associated with computing device122, or in any other suitable fashion. Using computing device 122,various views of the three-dimensional model or enhanced two-dimensionalimages generated from the three-dimensional model are presented. Theenhanced two-dimensional images may possess some three-dimensionalcapabilities because they are generated from three-dimensional data. Thethree-dimensional model may be manipulated to facilitate identificationof target on the three-dimensional model or two-dimensional images, andselection of a suitable pathway through patient P's airways to accesstissue located at the target can be made. Once selected, the pathwayplan, three-dimensional model, and images derived therefrom, can besaved and exported to a navigation system for use during the navigationphase(s).

With respect to the navigation phase, a six degrees-of-freedomelectromagnetic locating or tracking system 114, or other suitablesystem for determining position and orientation of a distal portion ofthe catheter 102, is utilized for performing registration of the imagesand the pathway for navigation. Tracking system 114 includes thetracking module 116, a plurality of reference sensors 118, and thetransmitter mat 120 (including the markers). Tracking system 114 isconfigured for use with a locatable guide 110 and particularly sensor104. As described above, locatable guide 110 and sensor 104 areconfigured for insertion through catheter 102 into patient P's airways(either with or without bronchoscope 108) and are selectively lockablerelative to one another via a locking mechanism.

Transmitter mat 120 is positioned beneath patient P. Transmitter mat 120generates an electromagnetic field around at least a portion of thepatient P within which the position of a plurality of reference sensors118 and the sensor 104 can be determined with use of a tracking module116. A second electromagnetic sensor 126 may also be incorporated intothe end of the catheter 102. The second electromagnetic sensor 126 maybe a five degree-of-freedom sensor or a six degree-of-freedom sensor.One or more of reference sensors 118 are attached to the chest of thepatient P. Registration is generally performed to coordinate locationsof the three-dimensional model and two-dimensional images from theplanning phase, with the patient P's airways as observed through thebronchoscope 108, and allow for the navigation phase to be undertakenwith knowledge of the location of the sensor 104.

Registration of the patient P's location on the transmitter mat 120 maybe performed by moving sensor 104 through the airways of the patient P.More specifically, data pertaining to locations of sensor 104, whilelocatable guide 110 is moving through the airways, is recorded usingtransmitter mat 120, reference sensors 118, and tracking system 114. Ashape resulting from this location data is compared to an interiorgeometry of passages of the three-dimensional model generated in theplanning phase, and a location correlation between the shape and thethree-dimensional model based on the comparison is determined, e.g.,utilizing the software on computing device 122. In addition, thesoftware identifies non-tissue space (e.g., air filled cavities) in thethree-dimensional model. The software aligns, or registers, an imagerepresenting a location of sensor 104 with the three-dimensional modeland/or two-dimensional images generated from the three-dimension model,which are based on the recorded location data and an assumption thatlocatable guide 110 remains located in non-tissue space in patient P'sairways. Alternatively, a manual registration technique may be employedby navigating the bronchoscope 108 with the sensor 104 to pre-specifiedlocations in the lungs of the patient P, and manually correlating theimages from the bronchoscope to the model data of the three-dimensionalmodel.

Though described herein with respect to EMN systems using EM sensors,the instant disclosure is not so limited and may be used in conjunctionwith flexible sensor, ultrasonic sensors, or without sensors.Additionally, the methods described herein may be used in conjunctionwith robotic systems such that robotic actuators drive the catheter 102or bronchoscope 108 proximate the target.

In accordance with the disclosure, the catheter 102 and its articulationand orientation relative to a target is achieved using a catheter drivemechanism 300. One example of such a drive mechanism can be seen in FIG.3A which depicts a housing including three drive motors to manipulate acatheter extending therefrom in 5 degrees of freedom (e.g., left, right,up, down, and rotation). Other types of drive mechanisms including feweror more degrees of freedom and other manipulation techniques may beemployed without departing from the scope of the disclosure.

As noted above, FIG. 3 depicts a drive mechanism 300 housed in a body301 and mounted on a bracket 302 which integrally connects to the body301. The catheter 102 connects to and in one embodiment forms anintegrated unit with internal casings 304 a and 304 b and connects to aspur gear 306. This integrated unit is, in one embodiment rotatable inrelation to the housing 301, such that the catheter 102, internalcasings 304 a-b, and spur gear 306 can rotate about shaft axis “z”. Thecatheter 102 and integrated internal casings 304 a-b are supportedradially by bearings 308, 310, and 312. Though drive mechanism 300 isdescribed in detail here, other drive mechanisms may be employed toenable a robot or a clinician to drive the catheter to a desiredlocation without departing from the scope of the disclosure.

An electric motor 314R, may include an encoder for converting mechanicalmotion into electrical signals and providing feedback to the computingdevice 122. Further, the electric motor 314R (R indicates this motor iffor inducing rotation of the catheter 102) may include an optional gearbox for increasing or reducing the rotational speed of an attached spurgear 315 mounted on a shaft driven by the electric motor 314R. Electricmotors 314LR (LR referring to left-right movement of an articulatingportion 317 of the catheter 102) and 314UD (referring to up-downmovement of the articulating portion 317), each motor optionallyincludes an encoder and a gearbox. Respective spur gears 316 and 318drive up-down and left-right steering cables, as will be described ingreater detail below. All three electric motors 314 R, LR, and UD aresecurely attached to the stationary frame 302, to prevent their rotationand enable the spur gears 315, 316, and 318 to be driven by the electricmotors.

FIG. 3B depicts details of the mechanism causing articulating portion317 of catheter 102 to articulate. Specifically, the following depictsthe manner in which the up-down articulation is contemplated in oneaspect of the disclosure. Such a system alone, coupled with the electricmotor 314UD for driving the spur gear 1216 would accomplish articulationas described above in a two-wire system. However, where a four-wiresystem is contemplated, a second system identical to that describedimmediately hereafter, can be employed to drive the left-right cables.Accordingly, for ease of understanding just one of the systems isdescribed herein, with the understanding that one of skill in the artwould readily understand how to employ a second such system in afour-wire system. Those of skill in the art will recognize that othermechanisms can be employed to enable the articulation of a distalportion of a catheter and other articulating catheters may be employedwithout departing from the scope of the disclosure.

To accomplish up-down articulation of the articulating portion 317 ofthe catheter 102, steering cables 319 a-b may be employed. The distalends of the steering cables 319 a-b are attached to, or at, or near thedistal end of the catheter 102. The proximal ends of the steering cables319 a-b are attached to the distal tips of the posts 320 a, and 320 b.As shown in FIG. 12 , the posts 320 a and 320 b reciprocatelongitudinally, and in opposing directions. Movement of the posts 320 acauses one steering cable 319 a to lengthen and at the same time,opposing longitudinal movement of post 320 b causes cable 319 b toeffectively shorten. The combined effect of the change in effectivelength of the steering cables 319 a-b is to cause joints a forming thearticulating portion 317 of catheter 102 shaft to be compressed on theside in which the cable 319 b is shortened, and to elongate on the sidein which steering cable 319 a is lengthened.

The opposing posts 320 a and 320 b have internal left-handed andright-handed threads, respectively, at least at their proximal ends. Asshown in FIG. 13 housed within casing 304 b are two threaded shafts 322a and 322 b, one is left-hand threaded and one right-hand threaded, tocorrespond and mate with posts 320 a and 320 b. The shafts 322 a and 322b have distal ends which thread into the interior of posts 320 a and 320a and proximal ends with spur gears 324 a and 324 bb. The shafts 322 aand 322 b have freedom to rotate about their axes. The spur gears 324 aand 324 b engage the internal teeth of planetary gear 326. The planetarygear 326 also an external tooth which engage the teeth of spur gear 318on the proximal end of electric motor 314UD.

To articulate the catheter in the upwards direction, a clinician mayactivate via an activation switch (not shown) for the electric motor314UD causing it to rotate the spur gear 318, which in turn drives theplanetary gear 326. The planetary gear 326 is connected through theinternal gears 324 a and 324 b to the shafts 322 a and 322 b. Theplanetary gear 326 will cause the gears 324 a and 324 b to rotate in thesame direction. The shafts 322 a and 322 b are threaded, and theirrotation is transferred by mating threads formed on the inside of posts320 a and 320 b into linear motion of the posts 320 a and 320 b.However, because the internal threads of post 320 a are opposite that ofpost 320 b, one post will travel distally and one will travel proximally(i.e., in opposite directions) upon rotation of the planetary gear 326.Thus, the upper cable 319 a is pulled proximally to lift the catheter102, while the lower cable 319 b must be relaxed. As stated above, thissame system can be used to control left-right movement of the endeffector, using the electric motor 314LR, its spur gear 316, a secondplanetary gear (not shown), and a second set of threaded shafts 322 andposts 320 and two more steering cables 319. Moreover, by acting inunison, a system employing four steering cables can approximate themovements of the human wrist by having the three electric motors 314 andtheir associated gearing and steering cables 319 computer controlled bythe computing device 122.

Though generally described above with respect to receiving manual inputsfrom a clinician as might be the case where the drive mechanism is partof a hand-held catheter system, the disclosure is not so limited. In afurther embodiment, the drive mechanism 300 is part of a robotic systemfor navigating the catheter 102 to a desired location within the body.In accordance with this disclosure, in instances where the drivemechanism is part of a robotic catheter drive system, the position ofthe distal portion of the catheter 102 may be robotically controlled.

The drive mechanism may receive inputs from computing device 122 oranother mechanism through which the surgeon specifies the desired actionof the catheter 102. Where the clinician controls the movement of thecatheter 102, this control may be enabled by a directional button, ajoystick such as a thumb operated joystick, a toggle, a pressure sensor,a switch, a trackball, a dial, an optical sensor, and any combinationthereof. The computing device responds to the user commands by sendingcontrol signals to the motors 314. The encoders of the motors 314provide feedback to the control unit 24 about the current status of themotors 314.

In accordance with the disclosure, and as outlined in greater detailbelow, the drive mechanism 300 receives signals derived by the computingdevice 122 to drive the catheter 102 (e.g., extend and retractpull-wires) to maintain the orientation of the distal tip of thecatheter 102 despite extension of a tool such as a biopsy needle orablation catheter or movements caused by respiration and cardiac cycles.

As described in connection with FIGS. 3A and 3B, catheter 102 isoperated on its proximal end through a collection of controls forrotation and distal tip deflection. In contrast, to the embodimentdescribed in connection with FIGS. 3A and 3B, a manually advancedcatheter 102 may not include the motor 314R, relying instead on manualmanipulation for rotation of the catheter 102. Alternatively, the drivemechanism may include only a single wire 319, or a single pair of wires319 a, 319 b. In such an embodiment, articulation is enabled in a singleor in a pair of wires in opposite directions. One or more knobs orlevers or wheels on the proximal handle control or energize the energizethe respective motor 314 to enable for distal tip articulation. Rotationand advancement/extraction of the catheter 102 are controlled directlyby the user's hand pushing, pulling and rotating the catheter 102 withinthe patient. As described in connection with FIGS. 3A and 3B, any or allof these manual controls can be removed, and users indirectly controlthe catheter operation through an interface to the motors such as ajoystick. Navigation may also be fully automatic with user oversight.

Following planning, registration, and then navigation of a catheter 102proximate the target, a user interface (UI) 200 on computing device 122may depict an image as seen in FIG. 2 . UI 200 depicts a rearperspective view of a virtual distal tip 202 of catheter 102. Theposition of the virtual distal tip 202 relative to the virtual target204 is displayed in the UI 200. This displayed position is based on thedetected position of the catheter 102, and more particularly the sensors104, 126 relative to the location of the target as identified in thepre-procedure scan from which the 3D model as derived. This relativeposition relies on the registration to provide accuracy. However,whether manual or robotic, as noted above, the pathway plan and 3D modeldeveloped from the pre-procedure scan data must be registered to thepatient before navigation of the catheter to a target within the anatomycan being.

Accordingly, a local registration process operating on computing device122 may be employed. In accordance with the local registration process,once catheter 102 has been successfully navigated proximate, as shown inFIG. 2 , the target 202 a local registration process 400 may beperformed for each target to reduce the CT-to-body divergence. Aninitial step 402 a sequence of fluoroscopic images is captured viafluoroscopic imaging device 124 for example from about 30 degrees on oneside of the AP position to about 30 degrees on the other side of the APposition. At step 404 a fluoroscopic 3D reconstruction may be thengenerated by the computing device 122. The generation of thefluoroscopic 3D reconstruction is based on the sequence of fluoroscopicimages and the projections of structure of markers incorporated withtransmitter mat 120 on the sequence of images. Following generation ofthe fluoroscopic 3D reconstruction, two fluoroscopic images aredisplayed on computing device 122 at step 406. At step 408 the distaltip of the catheter 102 is marked in each of these images. The twoimages are taken from different portions of the fluoroscopic 3Dreconstruction. The fluoroscopic images of the 3D reconstruction may bepresented on the user interface in a scrollable format where the user isable to scroll through the slices in series if desired.

Next at step 410 the target needs to be identified in the fluoroscopic3D reconstruction. In one example, the clinician will be asked to markthe target in two different perspectives of the 3D reconstruction. Atstep 412, the entire fluoroscopic 3D reconstruction may be viewed toensure that the target remains within an identified location, such as acircle placed on the target throughout the fluoroscopic 3Dreconstruction. At step 414 the local registration can be accepted. Atstep 416 the relative position of the virtual catheter 202 in the 3Dmodel relative to the virtual target 204 is updated to display theactual current relative position of the end of the catheter 102 and thetarget calculated by the local registration process 400. By the localregistration process the offset between the location of the target andthe tip of the catheter 102 is determined as they are observed in thefluoroscopic 3D reconstruction. The offset is utilized, via computingdevice 122, to correct any errors in the original registration processand minimize any CT-to-body divergence. As a result, the location and ororientation of the navigation catheter on the GUI with respect to thetarget is updated. At this point the clinician has a high degree ofconfidence in the position of the catheter 102 relative to the target asdisplayed in the UI 200.

By the process described above the relative positions of the catheter102 and the target are marked in the 3D fluoroscopic reconstruction andthe offset determined. In addition, the position of the catheter 102 isalways being sensed either in the EM field to provide EM coordinates ofits position, or in robotic coordinates if a robot is employed. Theoffset can then be used to update the position of the virtual distal tip202 in UI 200 relative to the virtual target 204. Thus improving theregistration and providing a clearer indication of the relativepositions of the virtual distal tip 202 and virtual target 204, thatmore closely depicts the actual relative positions of the distal tip ofthe catheter 102 and the target in the patient.

While far improved, the local registration process 400 does not accountfor movement of the catheter 102 or the target caused by respiration orheartbeat. Further, after the local registration process, the clinicianor robot will typically remove the LG 110 with sensor 104 from thecatheter 102 and insert a medical device in the catheter 102 and advancethe medical device towards the target. As will be appreciated, inaddition to the effects of respiration and heartbeat the relativepositions of the catheter 102 and the target can be affected by theremoval of the LG and the insertion of other tools. Thus, while thelocal registration is an improvement and overcomes the CT to bodydivergence, it is necessarily a static update to the relative positionsof the catheter 102 and the target.

As noted above, maintaining distal tip location and orientation to thetarget is difficult as the patient's body is moving due to pulmonary andcardiac activity along with muscle motion and disturbances cause byexternal forces such as the surgical staff moving the patient.Additional motion can be caused by motion of equipment around thepatient such as surgical bed or anesthesia tube motion. These motionscause external forces that can alter the amount of distal tiparticulation of the catheter 102, cause the catheter 102 to move forwardor backward, or impart rotational forces on the catheter 102. If thecatheter 102 is used as a tool to interact with the target location suchas a lesion or is used to deploy a tool through a lumen in the catheter,the target anatomy can distort or move due to pressure from the tooldeployment. As an example, deployment of a needle to perform biopsy on alesion adjacent to a bronchial tube can result in movement of thecatheter 102. The action of the needle perforating the stiffer,cartilage-like airway can distort the softer lung tissue behind causingboth the lesion and the catheter 102 to move and the needle miss. Thus,the 3D model and the sensed position of the catheter 102, as depicted inFIG. 2 , even after a local registration process 400 cannot be reliedupon to confirm that the tip of the catheter 102 is oriented towards(i.e., pointed at a target) at any particular time, and further that thetip of the catheter 102 remains in this orientation when tools areinserted therethrough for biopsy and treatment of the target.

A further aspect of the disclosure is directed to the use of an inertialmeasurement unit (IMU) within catheter 102. For some of theseapplications the IMU 328 may be configured as a small microchipmeasuring as little as 2 mm×2 mm in size and less than 1 mm inthickness. As will be appreciated, such a small size makes IMUS veryuseful in medical navigation applications in accordance with thedisclosure. However, other size devices may be employed withoutdeparting from the scope of the disclosure.

An IMU 328 is a sensor typically including one or more accelerometers,and one or more gyroscopes. Additionally, an IMU 328 may include one ormore of a magnetometer, a pressure sensor, and other types of sensors.An IMU 328 provides individual velocity and acceleration measurements inthe X, Y, and Z directions as well as roll about the X, Y, and Z axes.Using trigonometric operations, these measurements can be converted intoa directional vector showing which way the IMU 238 is moving. Combiningtwo vectors allows for calculation of distance traveled. While theeffects of gravity need to be compensated for at all times, the gravityvector can be used to identify the orientation of the sensor.Identification of the orientation of the IMU 328 provides an indicationof the orientation of the catheter 102. Thus, this in addition to usingthe local registration process 400 to determine the location of thedistal portion of the catheter 102 relative to the target, the IMU 328can be utilized to determine an orientation of the distal tip of thecatheter 102.

FIG. 5 depicts a catheter 102 as it may appear on a UI 500 followingnavigation proximate a target. By including an IMU 328 in the distalportion of the catheter 102, the plane 502 defined by the opening 504 inthe end of the catheter 102 can be determined using an applicationrunning on the computing device 122. The plane 502 which coincides withthe opening 504 allows for determination of a vector 506 which asdepicted in FIG. 5 is normal to a plane 502 transverse to the length ofthe catheter 102. The vector 506 depicts the path that a tool, such as abiopsy or treatment tool, extended from the opening 504 at the distalend of the catheter 102 would follow if extended from the distal tip ofthe catheter 102. As can be seen in FIG. 5 , the vector 506 does notcoincide with a vector from the catheter 102 to the target 508, thus atool extended from the catheter would miss the target 508. The angle θrepresents the 3D angle of change in orientation of the distal tip ofthe catheter 102 required to have plane 502 oriented such that itsorientation is such that a vector 510 extending normal to the plane 502intersects the target 508.

A further aspect of the use of an IMU 328 is that its movement can betracked throughout its navigation through the luminal network. As such,the effects of physiological forces from respiration and cardiacfunction can be detected and isolated from the overall movement of thecatheter 102. In a sense, the IMU 328 can act as both a respiration ratemonitor and a heart rate monitor. In some instances, this may require apause to the navigation process to allow for collection of movement datawhile the catheter 102 is not otherwise being moved.

With collection of the physiological data such as heart rate andrespiration rate, the movement of the distal portion of the catheter 102caused by these physiological functions can be determined and tracked bythe application running on computing device 122. Tracking can occurthroughout the navigation process and the estimates of the movementcaused by each force applied to the catheter 102 (e.g. motor force, handmanipulation, tissue responsive forces, and physiological forces) can becalculated and updated throughout navigation. And once proximate atarget, as depicted in FIG. 5 the movement caused by the physiologicaldata can be further refined and utilized as described in greater detailbelow.

As will be understood by those of skill in the art, even with motorizedcontrol as depicted in FIGS. 3A and 3B, known systems have difficulty inmaintaining the orientation of the distal tip of the catheter 102 withrespect to the target. In fact, known systems are generally notconcerned with orientation of the catheter 102, but rather focus onmaintaining the position and location or the articulation of thecatheter. This is typically done through the use of sensors such as EMsensors or shape sensors. These known systems detect changes in theposition or articulation of the distal tip and seek to counteract thatmovement through use of the motors to return the catheter 102 to thedesired shape or to return the catheter 102 a desired position. However,such designs do not account for anatomic changes where the target'slocation in space is moving independent of any movement of the distaltip of the catheter 102. Rather these systems seek to maintain theposition of the catheter 102 as determined in, for example, EMcoordinates. But typically, there are no EM coordinates for the target,and more importantly there is no ability to utilize EM coordinates totrack movement of the target. Still further, the entire patient, or atleast a significant portion of them is also moving meaning that not onlyis the location of the target moving because of the physiologicalforces, but in fact the entire or a substantial portion of the entirepatient.

A further aspect of the disclosure is directed to a method of addressingthe above-identified shortcoming of prior catheter navigation systems.As described above, the method 600 may optionally start at step 602 withnavigating a catheter 102 into a luminal network of a patient. Thisnavigation may be manual or robotically driven and may follow apre-planned pathway through a 3D model derived from pre-procedure imagessuch as CT images. Further, prior to the onset of navigation the 3Dmodel may be registered to the patient as described above. Those ofskill in the art will recognize that method 600 may also begin afternavigation and commence with step 604 wherein IMU 328 associated withthe catheter 102 collects data related to movement of the catheter. Thisdata regarding movement of the catheter 102, and particularly the IMU328 enables determination of both respiration and heart rate data andthe movements caused by the physiological forces. As an optional step606, a UI on a display of computing device 122 may prompt the user to“Stop movement” of the catheter 102, allowing the IMU to collect justthe physiological movement data (e.g., that caused by heartrate,breathing, and other internal muscular contractions of the patient).

After reaching a desired proximity to a target 508 at step 608, forexample between 2 and 5 CM from the target for example based ondetection of the position of the catheter via the EM sensor 104, afluoroscopic sweep is acquired of the end of the catheter 102 and thetarget 508 at step 610. Following the process described above, the endof the catheter 102 and the target 508 are marked in images derived fromthe fluoroscopic sweep at step 612. At step 614 the orientation of thedistal tip of the catheter 102 is determined based on the data receivedfrom the IMU 328. At step 616 the application determines whether theorientation of the distal tip of the catheter 102 is such that a vectorperpendicular to a plane 502 defined by the opening 504 in the distaltip is pointed at the target 508. If the answer is no, at step 618 theapplication running on computing device 122 can signal the motors 314 toadjust the articulation of the catheter 102 to achieve the correctorientation based a 3D angle between the vector 506 that does notintersect the target 508 and a vector 510 that would intersect thetarget 508. As an alternative the computing device 122 may provide anoutput in a UI on a display of the computing device of the movementnecessary to achieve an orientation of the opening 504 such that thevector traverses the target. If the answer is yes, the method proceedsto step 620, where the movement data collected by the IMU relating theheart rate and respiration (as well as other muscle movements) isutilized by the application to provide drive signals to the motors 314of the catheter 102 to maintain the orientation of the opening 504relative to the target.

At step 622, if other operations are undertaken such as removal of theLG or insertion of a biopsy needle, the position and orientation of thecatheter 102 is maintained by the application running on computingdevice 122. The IMU 328 outputs signals relating to its orientationwhich is associated with the orientation of the plane 502 at the ofopening 504 of the catheter 102. When movement of the IMU 328 isdetected, based on these user activities the application running on thecomputing device 122 generates signals to the motors 314 to adjust theshape of the distal portion of the catheter 102 to correct any change inorientation relative to the target.

Further, as part of step 622 the movements of the catheter 102 andparticularly the IMU 328 caused by respiration and heartbeat can bedetected. Because these are highly cyclical and repeated movements theapplication running on the computing device and generate signals whichare sent to the motors 314 to adjustment the position of the distalportion of the catheter 102 such that opening 504 remains oriented atthe target 500 throughout the cardiac and respiratory cycles.

The maintaining of the orientation of the distal end of the catheter 102may be occur automatically, with drive signals being generated bycomputing device 122 and delivered to the motors 314 to counteract themovements of the distal tip of the catheter 102. Alternatively, themovement of the distal portion of the catheter 102 can be manuallycontrolled either via switches, levers, or a wheel associated with themotors 314 to achieve the desired orientation of the opening 504 towardsthe catheter. The need for, the magnitude and the direction of thesemovements may be presented on a UI 200.

Whether manually initiated or controlled or partially controlled viacomputing device 122 the amount and speed of the movements the catheter102 caused by the motors 314 can be gated based on the proximity to thetarget. Thus, when navigating the central airways or larger lumenslarger movements of the end of the catheter 102 are possible. As thecatheter 102 approaches a target 500, particularly a target locatedcloser to the periphery of the lung or other bodily organ, the range ofavailable movements of the distal portion of the catheter 102 may bereduced. This reduction can increase the safety of the movementsparticularly in the periphery of organs like the lungs. Thedetermination of proximity of these locations may be based on thetracking system 114 employing the EM sensor 104 or a shape sensor, asdescribed above.

Similarly, the amount of drift or error in orientation of the opening504 in the catheter 104 towards the target 500 can be adjusted asdesired by the user or to the limits of the processing power and speedof the computing device 122. Where a user desires continual movement ofthe catheter 102 to confirm orientation the amount of acceptable driftcan be reduced. Alternatively, if fewer movements are desired, forexample due to the tissue being navigated, the acceptable drift can beincreased, and the signals will be sent from the computing deice 122 tothe motors 314 less frequently.

Still further, because of the cyclical nature of these physiologicalforces, the application running on the computing device can anticipatedthe application of forces on the catheter 102 and begin application ofcompensating signals at a timing to ensure proper orientation at alltimes.

In one embodiment, the representations of the virtual catheter tip 202and target 204 can be seen to move in the images displayed in the UI 200in concert with the physiological signals. The images may be livefluoroscopic images, 3D model images from the pre-procedure imaging andpathway plan, or other imaging modalities. In an embodiment where the UI200 displays 3D model images the viewer is afforded a virtual image ofthe reality of the movements occurring within the patient. In the UI 200in this embodiment the distal portion of the virtual catheter tip 202may be seen to flex to maintain the orientation towards the virtualtarget 204.

In a further embodiment, the UI 200 may include an indicator. Forexample, a portion of the UI 200 may have a portion which either changesbrightness or changes color (e.g., from red to yellow to green).Alternatively, movements caused by respiration and cardiac function canbe graphed over time, and portions of the graph may include a colorindicator or include a color band. The indicator can be timed relativeto the cardiac and respiratory forces applied to the catheter 102.Despite the articulation of the catheter 102 to maintain the orientationof the opening 504 towards the target 500, in some circumstances eitherthe user may find it desirable to or the application running oncomputing device 122 can be configured to limit the timing of the use oftools to only those portions of the cyclical movement caused by thephysiological forces that correspond to the approximate timing in therespiratory and cardiac cycle of when the fluoroscopic images wereacquired. By performing this gating, a further confirmation that despitethe movement of the target and the catheter 102, and even though the IMU328 has been utilized to articulate the catheter 102, the catheter 102and the target at these portions of the cardiac and respiratory cycleare now substantially at the same locations (e.g., in the same phase ofthe cardiac and respiratory cycle) as when the original orientationconfirmation was acquired.

In a further aspect of the disclosure, the imaging system foridentification of the catheter 102 and the target could be an ultrasoundsystem, computed tomography (CT) system, cone beam CT system, MRI systemor another capable system of imaging both the catheter 102 and thetarget simultaneously. Further, though described herein as occurringjust once, the external imaging (e.g., fluoroscopy, ultrasound,) may berepeated at intervals during the procedure to ensure continuedorientation of the catheter tip and the target. Still further, thoughtdescribed herein as being identified by a user viewing the fluoroscopicor ultrasound images to determine the location and orientation of thecatheter 102 relative to the target and the location of the target,these systems and methods described herein may additionally oralternatively employ automatic identification methods. Such automaticmethods may use image processing software to automatically identify thedistal tip and its orientation from the imaging system output.

Still further, in embodiments of the disclosure the maintaining oforientation of the distal tip of the catheter 102 and the target is afeature that can be turned on and off by the user or automaticallywhenever the catheter is greater than a preset distance from the target.Still further, the UI 200 may include an indicator to alert the user ifthe orientation lock between the catheter 102 and the target is everlost. Such a feature may also indicate that the external imaging neededto be renewed so that the method 600 can be started a new. As will beappreciated, this orientation lock may be turned may be selectivelyturned on or off as desired by the user or by the application running oncomputing device 120.

Reference is now made to FIG. 7 , which is a schematic diagram of asystem 700 configured for use with the methods of the disclosureincluding the method of FIG. 6 . System 700 may include a workstation701, and optionally an imaging device 715 (e.g., a fluoroscope or anultrasound device). In some embodiments, workstation 701 may be coupledwith imaging device 715, directly or indirectly, e.g., by wirelesscommunication. Workstation 701 may include a memory 702, a processor704, a display 706 and an input device 710. Processor or hardwareprocessor 704 may include one or more hardware processors. Workstation701 may optionally include an output module 712 and a network interface708. Memory 702 may store an application 718 and image data 77.Application 718 may include instructions executable by processor 704 forexecuting the methods of the disclosure including the method of FIG. 6 .

Application 718 may further include a user interface 716. Image data 714may include the CT scans, the generated fluoroscopic 3D reconstructionsof the target area and/or any other fluoroscopic image data and/or thegenerated one or more slices of the 3D reconstruction. Processor 704 maybe coupled with memory 702, display 706, input device 710, output module712, network interface 708 and imaging device 715. Workstation 701 maybe a stationary computing device, such as a personal computer, or aportable computing device such as a tablet computer. Workstation 701 mayembed a plurality of computer devices.

Memory 702 may include any non-transitory computer-readable storagemedia for storing data and/or software including instructions that areexecutable by processor 704 and which control the operation ofworkstation 701 and, in some embodiments, may also control the operationof imaging device 715. Imaging device 715 may be used to capture asequence of fluoroscopic images based on which the fluoroscopic 3Dreconstruction is generated and to capture a live 2D fluoroscopic viewaccording to this disclosure. In an embodiment, memory 702 may includeone or more storage devices such as solid-state storage devices, e.g.,flash memory chips. Alternatively, or in addition to the one or moresolid-state storage devices, memory 702 may include one or more massstorage devices connected to the processor 704 through a mass storagecontroller (not shown) and a communications bus (not shown).

Although the description of computer-readable media contained hereinrefers to solid-state storage, it should be appreciated by those skilledin the art that computer-readable storage media can be any availablemedia that can be accessed by the processor 704. That is, computerreadable storage media may include non-transitory, volatile andnon-volatile, removable and non-removable media implemented in anymethod or technology for storage of information such ascomputer-readable instructions, data structures, program modules orother data. For example, computer-readable storage media may includeRAM, ROM, EPROM, EEPROM, flash memory or other solid-state memorytechnology, CD-ROM, DVD, Blu-Ray or other optical storage, magneticcassettes, magnetic tape, magnetic disk storage or other magneticstorage devices, or any other medium which may be used to store thedesired information, and which may be accessed by workstation 1001.

Application 718 may, when executed by processor 704, cause display 706to present user interface 716. User interface 716 may be configured topresent to the user a single screen including a three-dimensional (3D)view of a 3D model of a target from the perspective of a tip of amedical device, a live two-dimensional (2D) fluoroscopic view showingthe medical device, and a target mark, which corresponds to the 3D modelof the target, overlaid on the live 2D fluoroscopic view. An example ofthe user interface 716 is shown, for example, in FIG. 2 . User interface716 may be further configured to display the target mark in differentcolors depending on whether the medical device tip is aligned with thetarget in three dimensions.

Network interface 708 may be configured to connect to a network such asa local area network (LAN) consisting of a wired network and/or awireless network, a wide area network (WAN), a wireless mobile network,a Bluetooth network, and/or the Internet. Network interface 708 may beused to connect between workstation 701 and imaging device 715. Networkinterface 708 may be also used to receive image data 714. Input device710 may be any device by which a user may interact with workstation 701,such as, for example, a mouse, keyboard, foot pedal, touch screen,and/or voice interface. Output module 712 may include any connectivityport or bus, such as, for example, parallel ports, serial ports,universal serial busses (USB), or any other similar connectivity portknown to those skilled in the art. From the foregoing and with referenceto the various figures, those skilled in the art will appreciate thatcertain modifications can be made to the disclosure without departingfrom the scope of the disclosure.

While detailed embodiments are disclosed herein, the disclosedembodiments are merely examples of the disclosure, which may be embodiedin various forms and aspects. For example, embodiments of anelectromagnetic navigation system, which incorporates the target overlaysystems and methods, are disclosed herein; however, the target overlaysystems and methods may be applied to other navigation or trackingsystems or methods known to those skilled in the art. Therefore,specific structural and functional details disclosed herein are not tobe interpreted as limiting, but merely as a basis for the claims and asa representative basis for teaching one skilled in the art to variouslyemploy the disclosure in virtually any appropriately detailed structure.

What is claimed is:
 1. A system for maintaining orientation of acatheter relative to a target, comprising: a catheter configured togenerate signals relating to movement of a distal portion of thecatheter; and a computing device, the computing device including aprocessor and a memory, the memory storing thereon instructions thatwhen executed by the processor: receive signals from the catheterrelating to movement of the distal portion of the catheter; determine,using the received signals, movement of the distal portion of thecatheter caused by physiological forces; receive images depicting thedistal portion of the catheter and a target; identify the distal portionof the catheter and the target in the images; confirm that the distalportion of the catheter is proximate to the target; determine anorientation of the distal portion of the catheter relative to thetarget; and articulate the distal portion of the catheter in response tothe detected movement to achieve and maintain an orientation of thedistal portion of the catheter towards the target during the determinedmovement of the distal portion of the catheter caused by physiologicalforces based on the received signals when the distal portion of thecatheter is proximate to the target such that a tool extended from anopening at the distal portion of the catheter would intersect thetarget.
 2. The system according to claim 1, wherein the orientation ofthe distal portion of the catheter is determined using image analysis.3. The system according to claim 1, further comprising the memorystoring thereon further instructions, that when executed by theprocessor, determine a three-dimensional angle between a currentorientation of the distal portion of the catheter and an orientationwhere a vector extending from the distal portion of the catheterintersect the target.
 4. The system according to claim 4, furthercomprising the memory storing thereon further instructions, that whenexecuted by the processor, articulate the distal portion of the catheterto achieve the orientation where the vector extending from the distalportion of the catheter intersect the target.
 5. The system according toclaim 1, wherein the images are fluoroscopic or ultrasound images. 6.The system according to claim 1, wherein the physiological forces arecaused by respiration and cardiac functions.
 7. The system according toclaim 1, wherein the data is collected during navigation of the cathetertowards the target.
 8. The system according to claim 1, furthercomprising the memory storing thereon further instructions, that whenexecuted by the processor, present on a user interface a virtualcatheter tip and a virtual target.
 9. The system according to claim 8,further comprising the memory storing thereon further instructions, thatwhen executed by the processor, present an indicator on the userinterface when the physiological forces are in approximately the samephase of their cycle as when the distal portion of the catheter wasconfirmed oriented at the target.
 10. A system for maintainingorientation of a catheter relative to a target, comprising: a catheterconfigured to navigate within a luminal network; and a computing device,the computing device including a processor and a memory, the memorystoring thereon instructions that when executed by the processor: detectmovement of a distal portion of the catheter caused by physiologicalforces; receive images depicting the distal portion of the catheter anda target; identify the distal portion of the catheter and the target inthe images; confirm that the distal portion of the catheter is proximateto the target; determine an orientation of the distal portion of thecatheter relative to the target; and articulate the distal portion ofthe catheter in response to the detected movement to achieve andmaintain an orientation of the distal portion of the catheter towardsthe target during the detected movement of the distal portion of thecatheter caused by physiological forces when the distal portion of thecatheter is proximate to the target.
 11. The system according to claim10, wherein the orientation of the distal portion of the catheter isdetermined using image analysis.
 12. The system according to claim 10,further comprising the memory storing thereon further instructions, thatwhen executed by the processor, determine a three-dimensional anglebetween a current orientation of the distal portion of the catheter andan orientation where a vector extending from the distal portion of thecatheter intersect the target.
 13. The system according to claim 10,wherein the physiological forces are caused by respiration and cardiacfunctions.
 14. The system according to claim 10, further comprising thememory storing thereon further instructions, that when executed by theprocessor, determining a cyclic timing of the movement of the distalportion of the catheter due to physiological forces
 15. The systemaccording to claim 10, further comprising the memory storing thereonfurther instructions, that when executed by the processor, detect, basedon the detected movement of the catheter due to physiological forces, aheart rate and a respiration rate.
 16. A system for maintainingorientation of a catheter towards a target, comprising: a catheter; acomputing device, the computing device including a processor and amemory, the memory storing thereon instructions that when executed bythe processor: track, during navigation of the catheter within a luminalnetwork, movement of a distal portion of the catheter caused byphysiological forces; receive images depicting the distal portion of thecatheter and a target; confirm, based on the received images, that thedistal portion of the catheter is proximate to the target; determine anorientation of the distal portion of the catheter relative to thetarget; and articulate the distal portion of the catheter in response tothe detected movement to achieve and maintain an orientation of thedistal portion of the catheter towards the target during the detectedmovement of the distal portion of the catheter caused by physiologicalforces when the distal portion of the catheter is proximate to thetarget.
 17. The system according to claim 16, wherein the orientation ofthe distal portion of the catheter is determined using image analysis.18. The system according to claim 16, further comprising the memorystoring thereon further instructions, that when executed by theprocessor, determine a three-dimensional angle between a currentorientation of the distal portion of the catheter and an orientationwhere a vector extending from the distal portion of the catheterintersect the target.
 19. The system according to claim 16, wherein thephysiological forces are caused by respiration and cardiac functions.20. The system according to claim 16, further comprising the memorystoring thereon further instructions, that when executed by theprocessor, determining a cyclic timing of the movement of the distalportion of the catheter due to physiological forces